One, Two Punch

November’s Presidential election has bequeathed Americans with two jewels, a President temperately unfit to lead and a Congressional majority so wedded to the very wealthy that they are unfit to govern. How could Americans get it so wrong?

Yesterday, Congress stepped out from President Trump’s shadow and revealed its healthcare colors. Billed as Obamacare “repeal and replace”, the proposal was short on the replace portion.

The proposal calls for ending funding sources like the “individual mandate” and other Obamacare taxes, for example the 3.8% tax on investment income for higher earners. On the good side, the Republican plan will also keep the provisions for insuring children under 26 and good but less good, keeps the “pre-existing condition” exclusion. True to form, the GOP will allow insurers to raise premiums for pre-existing conditions if there is a break in enrollment (like if someone is laid off, fired, or decides to leave a job providing healthcare coverage). What’s wrong with a simple “no exclusions for life time limits or pre-existing conditions?

Under the GOP plan, direct subsidies are gone and in their place will be tax credits. I wonder how long Republicans thought about tax credits since most of those seeking healthcare premium subsidies do not report enough income to benefit much fom tax credits.

As predicted previously, the Republican plan will insure fewer Americans (especially the most vulnerable), do nothing to halt overall healthcare premium increases, and deliver a handsome tax reduction bonus to the very wealthy (who do not need the tax cut). Republican spokespersons speak of giving Americans greater choice, access to the doctors of their preference, and the unspecified benefits of a healthcare free market. Hmmm.

Anyone who thinks the healthcare market is suitable for “free market” principles is dreaming. Look at where the US is now, premiums are increasing two times the rate of inflation, insurance companies would reimpose life time limits and pre-existing conditions exclusions if they could. And how many Americans do you know who could shop among different doctors or hospitals for a good deal?

One Republican spokesperson cited a heart procedure which costs $150,000 in the US but in India, the same procedure goes for $15,000. Assuming this is true, there is no way “free market” causes this. Doctors, hospitals and drug companies simply are paid less in India.

Interestingly when one looks around the world, one sees the US spends twice as much as two dozen other modern countries and despite what the US spends, it experiences poorer health outcomes. In all these other countries, doctors, hospitals, and drug companies cost less than in the US. Hmmm.

Doesn’t it seem reasonable to expect any action to “make America great again” would also demonstrably produce healthcare outcomes equal to or superior to world class standards?